This is an agreement between a medical coding and billing services company and a healthcare provider for a third party company to exclusively provide coding and billing services in exchange for a percentage of the hospital’s gross income. The agreement requires the hospital to provide the company with the information necessary to process the claims and that the company will quickly process and submit the claims to insurance companies and individuals. The agreement also requires the company to provide reports to the hospital and keep the client data confidential. This document contains both standard clauses as well as opportunities for customization to ensure that the understandings of the parties are properly set forth.
This is an agreement between a medical coding and billing services company and a healthcare provider for a third party company to exclusively provide coding and billing services in exchange for a percentage of the hospital’s gross income. The agreement requires the hospital to provide the company with the information necessary to process the claims and that the company will quickly process and submit the claims to insurance companies and individuals. The agreement also requires the company to provide reports to the hospital and keep the client data confidential. This document contains both standard clauses as well as opportunities for customization to ensure that the understandings of the parties are properly set forth. SERVICE AGREEMENT THIS SERVICE AGREEMENT (the “Agreement”) made as of ___________ [Instruction: Insert Date], by and between ___________ [Instruction: Insert Name of Medical Coding and Billing Company], ___________ [Instruction: Insert Address] (“Company”), and ___________ [Instruction: Insert Name of Hospital], ___________ [Instruction: Insert Address] (“Client”). WHEREAS, Company is a healthcare coding, claims and billing service company which provides computerized claims, billing and collection services to healthcare providers; files medical insurance claims on behalf of healthcare providers with government and commercial companies; and provides for billing services directly to patients; and WHEREAS, Client is a healthcare provider that desires to retain Company to provide it with coding, claims and billing services; NOW, THEREFORE, in consideration of the promises and other good and valuable consideration set forth, the parties agree as follows: 1. Term. The term (“Term”) of this agreement shall commence upon complete execution hereof and shall continue for one (1) year. Thereafter, the Term shall automatically renew for successive one (1) year intervals, unless terminated by either party upon thirty (30) days’ prior written notice. 2. Company’s Services. A. Throughout the Term, Company will code and process all the Client's medical insurance claims for payment by government and commercial companies by either electronic or paper means. The Client agrees to make available to Company all information necessary to properly process the Client's claims and to submit all such billing and insurance information to Company on a daily basis. Said submissions shall be either be via email with scanned copies being sent to Company at ___________ [Instruction: Insert Email Address] or via facsimile, with copies being faxed to Company at ___________ [Instruction: Insert Fax Number]. Company will process and submit all Client’s claims within ___________ (___) [Instruction: Insert Amount] hours of its receipt by electronic means wherever possible, and by paper means otherwise. B. Throughout the Term hereof, Company shall provide to Client the following reports regarding the Client’s practice, on the following intervals: i. Insurance Aging Report – ___________ [Instruction: Insert Interval; i.e. weekly, month, quarterly, semi-annually, or annually] ii. Patient Aging Report – ___________ [Instruction: Insert Interval] iii. Practice Analysis – ___________ [Instruction: Insert Interval] iv. ___________ [Instruction: Insert Type of Report] -- ___________ [Instruction: Insert Interval] C. During the Term of this Agreement, Client will not use the services of any other claims processing and/or bill and service company and will allow Company to process all of the Client's medical insurance claims with the government and commercial companies. 3. Compensation. A. Upon execution hereof, Client will pay Company a one-time administrative fee in the amount of ___________ Dollars ($_____) [Instruction: Insert Amount] (the “Administrative Fee”). The Administrative Fee shall cover the cost of gathering information from the Client and setting up the Client's files for entry into computer system for coding and billing. B. In consideration of Company’s services hereunder, Client will pay to Company a service fee in the amount of ___________ percent (___%) [Instruction: Insert Percentage] of the gross income collected by Client from all insurance companies and patients, with a monthly minimum of ___________ Dollars ($_____) [Instruction: Insert Amount] (the “Service Fee”). Company will invoice the Client for its services on the 15th day of each month for the previous month's processing. Within Fifteen (15) days of receipt of said invoice, Client will (i) pay Company the Service Fee and (ii) provide Company with copies of all Explanation of Benefits (“EOB”) forms received from insurance companies to Company as well as records of payments received directly from patients from the previous month so that Company can verify that the amount paid by Client represents the appropriate amount of gross income. In the event that Client fails to make full payment of the Service Fee within the time set forth herein, Company may charge a late payment penalty of ___________ percent (___%) [Instruction: Insert Percentage], compounded [Instruction: Choose One: monthly // annually], on any unpaid balance. Client shall also be liable for legal or other fees and costs are incurred by Company to collect any past due amount. In addition, in the event that Client fails to make timely payment of the Service Fee, Company may, in its sole and absolute discretion and without prejudice to any rights Company may have against Client, cease to continue to display provide Company’s services hereunder. 4. Confidentiality. All patient information and data provided by the Client to Company shall be kept strictly confidential and shall not be disclosed to anyone outside of Company other than to the extent necessary for Company to process and submit claims for the Client. The parties hereto agrees that any disclosure of such information and data would cause irreparable damage to the Client, and in the event of such breach, the Client party shall have, in addition to any and all remedies at law, the right to an injunction, specific performance or other equitable relief to prevent the violation or threatened violation of the Company’s obligations hereunder. 5. Claims. Company will be serving as a conduit of information and claims data between Client and many insurance payers, both government and commercial. Client will be providing all such claims information and data to Company, including but not limited to procedure codes, identifying the exact procedures Client has performed on patients. Client verifies that all such procedures were in fact performed on the patients as specified. Company has no authority to and will not change any of these procedure codes without the express permission and direction of Client. Client understands that Company is relying entirely on the claims and billing information supplied to Company by Client in preparing and submitting insurance claims for payment on behalf of Client. Client represents and warrants that all such claims and billing information is entirely accurate and truthful. If any investigation is initiated or if any action is brought by any individual, company or entity whatsoever regarding any of the claims filed by Company on behalf of Client, then Client agrees to cooperate fully in any such investigation or action and shall provide all relevant supporting documentation to support the claim(s) filed. Client agrees to indemnify and hold Company harmless for any and all damages or penalties imposed and any attorney’s fees incurred by Company in defending any such action resulting from Client's failure to provide truthful and accurate billing and claims information to Company. 6. Miscellaneous. A. This Agreement constitutes the entire agreement between the parties hereto with respect to the specific subject matter hereof and supersedes all prior agreements or understandings of any kind with respect to the specific subject matter hereof. B. In the event that any provision or part of this Agreement shall be deemed void or invalid by a court of competent jurisdiction, the remaining provisions or parts shall be and remain in full force and effect. C. Any modification to this Agreement must be in writing and signed by the parties or it shall have no effect and shall be void. D. This Agreement is binding upon and shall inure to the benefit of the respective successors, licensees and/or assigns of the parties hereto. E. The waiver by either party of a breach or violation of any provision of this Agreement shall not constitute a waiver of any subsequent or other breach or violation. F. This Agreement shall be governed in accordance with the laws of the State of _____________ [Instruction: Insert State], applicable to agreements to be wholly performed therein, with jurisdiction exclusive to the Federal and State courts located in the County of _____________ [Instruction: Insert County], State of ______________ [Instruction: Insert State]. \ \ \ \ \ \ \ \ IN WITNESS WHEREOF the parties have duly executed this Agreement as of the date first written above. COMPANY: ________________________________ [Instruction: sign] By: ___________________________ [Instruction: Insert Name of Signatory] Title: ___________________________ [Instruction: Insert Title of Signatory] CLIENT: ________________________________ [Instruction: sign] By: ___________________________ [Instruction: Insert Name of Signatory] Title: ___________________________ [Instruction: Insert Title of Signatory]
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